Please complete this application form if you are interested in becoming a Ivinson Memorial Hospital volunteer to assist with COVID-19 vaccination efforts. Once you complete the form, click the Continue button at the bottom.

Contact Information

Contact Preferences

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.

Special Skills

To help us better understand what COVID-19 vaccination efforts you may be able to assist in, please fill out the information below.

Emergency Contact